Short- and Long-Term Effects of CBT-I in Groups for School-Age Children Suffering From Chronic Insomnia: The KiSS-Program.

OBJECTIVE/BACKGROUND: This intervention study evaluates the short- and long-term effects of cognitive behavior therapy for insomnia (CBT-I) in groups for school-age children and their parents, named the KiSS-program. CBT-I was implemented in three sessions for children and three sessions for parents. PARTICIPANTS AND METHODS: All in all, 112 children with chronic childhood insomnia were randomly assigned to a wait-list (WL) control or treatment condition. RESULTS: According to subjective measures as well as objective wrist actigraphy, children in the CBT-I condition reported greater improvements in sleep behavior immediately after the treatment compared to the WL group. Improvements in sleep behavior after CBT-I persisted over the 3-, 6-, and 12-month follow-up assessments. CONCLUSIONS: The present study is the first randomized controlled trial that provides evidence for the long-term effectiveness of CBT-I in treating school-age children with chronic insomnia.

Training medical students in motivational interviewing using a blended learning approach: a proof-of-concept study.

Background: Difficulties in implementing behavior change in patients with chronic diseases are common in clinical practice. Motivational interviewing (MI) helps clinicians to support patients in overcoming ambivalence while maintaining self-determination. The inclusion of MI in German medical training curricula is still rare. Furthermore, the effects of systematic teaching of MI, especially via blended learning, have hardly been investigated. Methods: Medical students participated in three curricular events related to MI, consisting of instructional videos and theoretical and practical components in a blended learning format. The aim of the study was to investigate the effect of teaching MI in students' medical education. A controlled, non-randomized study was conducted with an intervention group and a control group. Both groups completed questionnaires on their experience and knowledge related to MI, completed a knowledge test and rated their satisfaction with the course. MI was taught in the 6th semester of medical coursework as part of a psychosomatic course, in the 8th semester during a psychiatry course and in the 9th semester during a weekly psychiatry clerkship. Results: Data from the intervention group (n = 35) and control group (n = 14) were analyzed, with 65.7% of students participating in all three parts of the curriculum. Overall interest in learning MI was high, with M = 2.92 (SD = 1.00). The results indicate a greater increase in knowledge over time in the intervention group. The majority (62.86%) stated that the curriculum was relevant to their future career. Free-form text responses indicated a high level of satisfaction with practical relevance. Conclusion: This study demonstrates the usefulness of an MI curriculum for medical students. The integration of MI into medical curricula is a promising curricular addition to improve doctor-patient communication. Future research should address patient perceptions of MI competencies and the persistence of acquired competencies.

Trait rumination and social anxiety separately influence stress-induced rumination and hemodynamic responses.

We aimed to investigate stress-reactive rumination in response to social stress and its association with social anxiety and trait rumination. From previous investigations we know that people with a certain vulnerability to rumination show increased stress-reactive rumination. However, up to date the possible influence of social anxiety on this relationship is still unclear. Therefore, we reanalyzed the data of two of our previous studies assessing healthy low and high trait ruminators and depressed patients performing the Trier Social Stress Test (TSST). We measured cortical oxygenation using functional Near-Infrared Spectroscopy (fNIRS) as well as different behavioral outcome measures (subjective stress levels, negative affect, state rumination). On a behavioral level, we found an influence of both, social anxiety and trait rumination, on state rumination, even when correcting for the other factor, respectively, implying two potentially independent factors of influence. On a neural level, we observed reduced activation in brain regions of the cognitive control network (CCN) for higher social anxiety and trait rumination, which might be a result of reduced cognitive and attentional control. Results indicate a specific role of social anxiety, at least on a behavioral level, and therefore implicate a crucial factor to be considered in the treatment of depression.

Insights from a laboratory and naturalistic investigation on stress, rumination and frontal brain functioning in MDD: An fNIRS study.

Recent research has emphasized rumination as an important maintaining factor in various mental disorders. However, operationalization and therefore induction of rumination in experimental settings poses a major challenge in terms of ecological validity. As stress seems to play a key role in everyday situations eliciting rumination, we conducted two stress paradigms while assessing behavioral and neurophysiological measures. Aiming to replicate previous findings on induced rumination by means of the Trier Social Stress Test (TSST) and comparing them to physiological (pain) stress, a clinical sample of patients with Major Depressive Disorder (MDD; n = 22) and healthy controls (HC; n = 23) was recruited. Cortical blood oxygenation was assessed during the stress paradigms using functional near-infrared spectroscopy (fNIRS). Further, we used ecological momentary assessment (EMA) of stress, rumination and mood to be able to correlate ruminative responses during induced stress and everyday rumination. Our results showed that social stress but not physiological stress induced depressive rumination in MDD but not in HC. Further, rumination reactivity in response to social stress but not to physiological stress was significantly associated with rumination reactivity in everyday life as assessed with EMA. With respect to cortical oxygenation, MDD subjects showed hypoactivity in the Cognitive Control Network during the TSST, which mediated the differences between MDD and HC in post-stress rumination. Our findings emphasize the role of negative social triggers in depressive rumination and validate the TSST as an induction method for depressive rumination. The results inform future developments in psychotherapeutic treatment for depressive rumination.

Amplitude of low frequency fluctuations (ALFF) of spontaneous and induced rumination in major depression: An fNIRS study.

In the current study, we investigated the amplitude of low frequency fluctuations (ALFF) at rest and during a rumination induction. Specifically, we explored the differences of cortical blood oxygenation using fNIRS in subjects with Major Depressive Disorder (MDD) and healthy controls (HC). Rumination was assessed as state and trait measure, as well as with a qualitative semi-structured interview. Qualitative and quantitative measures of rumination indicated that the MDD group showed elevated rumination regarding state and trait measures. Furthermore, rumination differed qualitatively between the groups. The MDD group showed higher levels of general rumination and increased rumination during the rumination induction. However, the MDD group did not show a carry-over effect of elevated rumination after the induction paradigm to the following resting-state measurement. On a neuronal level, we observed a general hypoactivity in the MDD group compared to the HC group. Moreover, both groups showed increased ALFF during the rumination induction compared to the rest phase, especially in temporo-parietal areas. However, no interaction effect of MDD status and rumination induction was found. The current findings are discussed with respect to the literature of paradigms used in the investigation of rumination and suggestions on general improvements in rumination research are given.

First effects of a multicomponent treatment for sleep disorders in children.

Insomnia in children is a common disorder, yet only few child-specific treatment modalities exist so far. The goal of this study was to investigate the effectiveness of a multicomponent intervention program for children with insomnia at 5-10 years of age and their parents. The program was a structured six-session behavioral and hypnotherapeutic group treatment with three sessions for the children and three for their parents. Thirty-eight children (5.1-10.9 years) were randomly assigned to the specific treatment condition or waiting list plus sleep diary control condition. Twenty-two children participated in the treatment group and 16 in the control group. All children suffered from insomnia according to the International Classification of Sleep Disorders criteria. Sleep symptoms were assessed with a sleep diary and the German version of the Children Sleep Habit Questionnaire (CSHQ) and the Sleep Disturbance Scale for Children (SDSC). Although both conditions showed a significant decrease in several sleep symptoms, the treatment group exhibited a significantly greater improvement with regard to CSHQ and SDSC total scores as well as in several sleep parameters, reflecting the most important features of the intervention program, such as bedtime, sleep-related anxiety, night waking, and sleeping in parents' bed. By contrast, the control group's data revealed only unspecific effects. These pilot data suggest that insomnia in childhood can be treated effectively with this child-specific multicomponent group treatment.

Association between sleep patterns and daytime functioning in children with insomnia: the contribution of parent-reported frequency of night waking and wake time after sleep onset.

OBJECTIVE: The aim of this study was to investigate the association between sleep patterns and daytime functioning in children with insomnia. Furthermore, the role of frequency of night waking and wake time after sleep onset for daytime functioning was analyzed in the context of total sleep time and sleep onset latency. METHODS: Families with children with parent-perceived sleep problems were recruited for diagnostic clarification and subsequent treatment (if indicated) at an outpatient clinic. Out of 49 families seeking help, 34 children (age 5.2-10.9 years, mean 7.1 years) and their parents were included in the present study. Sleep and sleep problems were assessed by a structured clinical interview according to the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-II). Parents kept a sleep diary over two weeks. In addition, they answered the Child Behavior Checklist, questions concerning the daytime sleepiness of their children, as well as a structured clinical interview assessing comorbid mental disorders. RESULTS: Reduced parent-reported total sleep time predicted more delinquent behavior and more concentration problems. Independent of total sleep time and frequency of night waking, longer parent-reported wake time after sleep onset was associated with greater daytime sleepiness, which in turn predicted more social problems. CONCLUSIONS: Besides total sleep time, wake time after sleep onset could be another important determinant for specific aspects of daytime functioning in children with insomnia.